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Purpose To classify microaneurysms (MAs) and investigate the relationships with retinal edema in eyes with branch retinal vein occlusion (BRVO). Study design Retrospective, observational, consecutive case series. Methods Eyes with MAs due to BRVO that underwent optical coherence tomography angiography (OCTA) were enrolled. MAs on OCTA images were morphologically classified into six types: focal bulge, saccular, fusiform, mixed (saccular/fusiform), pedunculated, and irregular. The frequency, size, location, and relationships with retinal edema also were investigated. Results Twenty-four eyes of 23 patients (12 men, 11 women; mean age, 68.0 years) were enrolled. A total of 244 MAs were detected on the OCTA images. The focal bulge and saccular types accounted for over 70% of all MAs. Smaller MAs such as the focal bulge or saccular type also were detected both at the edge of the nonperfused areas (NPAs) and in collateral vessels. In contrast, larger MAs such as the pedunculated or irregular types tended to form at the edges of the NPAs. Older age, the presence of MAs in the collateral vessels, and the absence of pedunculated type were independent predictive factors for retinal edema but not the MA size, or presence in the retinal deep capillary plexus. After treatment, the mean retinal thickness decreased significantly, but the mean MA size remained unchanged. Conclusion OCTA enables morphologic classification, three-dimensional analysis, and investigation of the longitudinal changes of MAs with noninvasive volumetric quantification, leading to a better understanding of the pathology of MAs in eyes with BRVO.

We experienced a case of sympathetic ophthalmia in a fellow eye after vitrectomy for subretinal hemorrhage related to polypoidal choroidal vasculopathy. A 60-year-old male consulted us for polypoidal choroidal vasculopathy with subretinal hemorrhage in his left eye. The recurrence of massive subretinal hemorrhage refractory to repeated pars plana vitrectomies leads to phthisis bulbi. Two months later, multiple serous retinal detachments were observed in his right eye. Positive human leukocyte antigen-DR4 and the uveitis were helpful in distinguishing between sympathetic ophthalmia and age-related macular degeneration. High-dose pulse intravenous steroid contributed to recovery of visual acuity after resolution of serous retinal detachment.

Tetsuyuki Suetsugu,1,2 Aki Kato,1 Munenori Yoshida,1 Tsutomu Yasukawa,1 Akiko Nishiwaki,1,3 Norio Hasegawa,1 Hideaki Usui,1 Yuichiro Ogura1 1Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 2Department of Ophthalmology, General Kamiiida Daiichi Hospital, 3Nishiwaki Eye Clinic, Nagoya, Aichi, Japan Purpose: We aimed to evaluate the prevalence of abnormal peripheral fundus autofluorescence (FAF) in wet age-related macular degeneration (AMD) using wide-field imaging instrument. Patients and methods: A retrospective, case-controlled study involving 66 eyes of 46 Japanese wet AMD patients and 32 eyes of 20 control patients was performed. Wide-field FAF images were obtained for typical AMD (37 eyes/28 patients), polypoidal choroidal vasculopathy (PCV) (22 eyes/20 patients), and retinal angiomatous proliferation (RAP) (seven eyes/four patients). Two masked ophthalmologists independently graded the images for mottled, granular, and nummular patterns. Main outcome measures were abnormal peripheral FAF frequencies and relative risks by disease subgroups and treatments. Results: Abnormal peripheral FAF patterns were found in 51.5% of wet AMD eyes compared with 18.8% of control eyes (P

While the former gradually impairs the central vision, the latter causes rapid and severe vision loss. Anti-VEGF drugs, involving ranibizumab (Lucentis), bevaci -zumab (Avastin) and aflibercept (Eylea), improve visual outcomes in patients with neovascular AMD. However, exudative changes often recur and sometimes resist anti-VEGF therapies. Monthly injections are most promising to improve and sustain visual acuity

Recent advances in biotechnology enabled commercial production of humanized monoclonal antibodies. In the field of ophthalmology, ranibizumab and bevacizumab, anti-VEGF antibodies, are highly recognized as first-choice drugs to treat age-related macular degeneration, which is one of the major causes of legal blindness in developed countries. Infliximab is a monoclonal antibody against TNF-α and is effective in treating autoimmune diseases such as Behcet’s disease. Thus, these drugs proved the potential of antibodies as molecularly targeted therapies for the treatment of a variety of ocular diseases. A variety of cytokines may also possess great potential as therapeutics, exemplified by interferon for the treatment of chronic hepatitis C, multiple sclerosis, and other systemic diseases. However, intraocular delivery of bioactive proteins remains a critical problem to be overcome. The cornea, sclera, tear turnover, frontward current of aqueous humor, the blood–aqueous barrier and blood–retinal barrier stric...

The RPE may secrete C3 to enhance removal of waste products in Bruch’s membrane, and CFH for self-defense, while other components may be derived from blood to form the membrane attack complex (C5b-...

In general, vitreoretinal diseases are refractory to both topical and systemic pharmacological approaches because of the anatomical specificity of the eye. That is, the cornea, sclera, tear turnover, frontward current of aqueous humor, blood–aqueous barrier and blood–retinal barrier strictly limit penetration and diffusion of drugs into the chorioretinal tissue. However, recent advances in intraocular drug delivery systems have enabled some compounds to be targeted spatiotemporally into the posterior segments of the eye. Clinically successful or promising cases involve an intraocular nonbiodegradable implant containing ganciclovir for the treatment of cytomegalovirus retinitis, an intraocular biodegradable implant of dexamethasone for the treatment of macular edema, intravitreal or sub-Tenon’s injection of triamcinolone acetonide for the treatment of macular edema or exudative age-related macular degeneration (AMD) and a photodynamic therapy with verteporfin, a photosensitizer, for the treatment of exudat...

To investigate the potential role of endostatin, an endogenous angiogenesis inhibitor, in the prevention of choroidal angiogenesis-related disorders.Bovine choroidal endothelial cells (CEC) were cultured and treated with basic fibroblast growth factor (bFGF) alone or combined with endostatin at concentrations ranging from 0.1 to 10 microg/ml. The proliferation and migration of CECs were evaluated by using 3, (4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) colorimetric assay and modified Boyden chamber assay, respectively. For evaluating expression and secretion of matrix metalloproteinase-2 (MMP-2), CEC-conditioned media were subjected to zymography and/or Western blot analysis, and the cells were used for semiquantitative reverse transcription polymerase chain reaction (RT-PCR) analysis.Endostatin did not inhibit bFGF-induced or nonstimulated CEC proliferation (p0.05). The bFGF-induced migration was significantly inhibited by endostatin at concentrations of 1 and 10 microg/ml (p0.05). The bFGF-upregulated expression of mRNA in CECs and the secretion of MMP-2 protein of CECs were both suppressed by endostatin.Inhibitory effect of endostatin on expression and secretion of MMP-2 and cell migration, but not on proliferation of CECs, could respond to its therapeutic action for choroidal neovascularization-dependent disorders.

To investigate the effect of focal X-ray irradiation on experimental corneal angiogenesis in the rabbit.A gelatin hydrogel sheet impregnated with basic fibroblast growth factor was implanted into the corneal stroma of rabbits; this induced corneal angiogenesis. After the first sign of corneal angiogenesis was noted, the corneal region was irradiated with a dose of 10 Gy or 20 Gy. The control rabbits received no irradiation. The eyes were examined by slitlamp biomicroscopy and photographed, over a period of 28 days. The maximum length and total surface area of corneal angiogenesis were quantified by computerized image analysis.Corneal angiogenesis was noted on day 3 following implantation of the hydrogel sheet. In the rabbits irradiated with 10 Gy, the maximum length and total surface area of corneal angiogenesis were both significantly lower on day 4 and 7 following irradiation, compared to the respective measurement in the controls. In the rabbits irradiated with 20 Gy, the maximum length and total surface area of corneal angiogenesis were significantly lower between days 4 and 21, and between days 4 and 14, respectively, compared to the respective measurement in the controls.Focal X-ray irradiation to the corneal region suppressed corneal angiogenesis in a dose-dependent manner. Focal X-ray irradiation may be beneficial in treating ocular angiogenesis.

Yoshio Hirano, Tsutomu Yasukawa, Yuichiro OguraDepartment of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, JapanAbstract: Optical coherence tomography (OCT) has emerged as a powerful diagnostic aid in disorders of the vitreoretinal juncture. The purpose of this study is to determine whether OCT can be used as an additional tool for evaluating an architecture including the thickened area, and the identifiable edge of a macular epiretinal membrane (ERM), and helping us to dissect the ERM from the retinal surface more easily and safely. In two cases with ERM, the edges of the membranes were detected by OCT, and the peeling of the membrane was started at the area easily. OCT guided ERM peeling might be useful for dissecting ERM membranes without any hesitation.Keywords: optical coherence tomography, epiretinal membrane, vitrectomy